Auditory comprehension: is multiple choice really good enough?

Auditory comprehension is commonly measured with multiple choice tasks. The sensitivity of these tasks in identifying deficits, however, is limited by credit given for correct guesses by forced choice. In this study, we compare performance on the multiple choice task to an alternative word/picture verification task, in 122 subjects with acute left hemisphere stroke. As predicted, word/picture verification identifies significantly more subjects with deficits in auditory comprehension. Furthermore, the pattern of errors in the two tasks is consistent with a current distributed model of semantic memory, and inconsistent with alternative local models.     

Selective Deficit of One Language in a Bilingual Patient Following Surgery in the Left Perisylvian Area

We report on a right-handed bilingual patient with a left perisylvian arteriovenous malformation that caused a mild naming deficit evident only on formal language testing in both languages. Sodium amytal injected in the left carotid artery (Wada test) before surgery resulted in speech arrest for both languages. Following surgery for removal of the lesion she developed additional deficits in her native language without alteration in her second language. Selective impairment in one language after surgery demonstrates that each language has different anatomical representation within the perisylvian dominant area.     

Three variant forms of subcortical aphasia in Chinese stroke patients

Five right-handed patients with subcortical aphasia that involved the left hemisphere subcortical lesion sites were subjected to CT scans. Given their etiology, two cases were infarctions and the other three were hemorrhages. Two of the patients presented an involvement of the anterior limb of the internal capsule and of the basal ganglia and an anterior superior white-matter lesion extension. In both cases slow scanty dysarthric speech was noted; one had markedly impaired auditory comprehension, and the others were only partially impaired. The third patient presented an involvement of the posterior limb of the internal capsule and of the thalamus and a posterior paraventricular white-matter lesion extension. He had poor auditory comprehension, echolalia, and fluent speech. The last two patients presented an involvement of the internal capsule, the basal ganglia, and the thalamus and an anterior posterior paraventricular white-matter lesion extension. The latter two showed poor auditory comprehension with nonfluent and scanty spontaneous speech. The speech sounds were nonsensical monosyllabic words with a pattern similar to that of global aphasia. All patients had lasting right hemiplegia.     

Semantic disorders of auditory language comprehension in right brain-damaged patients

A test of auditory language comprehension was given to 110 right brain-damaged patients and to 94 normal controls in order to check if patients with lesions of the right (nondominant) hemisphere make a significantly higher number of semantic errors than normals. Confirmation of the hypothesis was obtained, but the relationship between semantic errors and lesion of the right hemisphere did not seem a simple and direct one. In fact, most of the lexical-semantic errors were due to associated variables (such as unilateral spatial agnosia and general mental deterioration) and not to the lesion of the right hemisphere per se. These data do not suggest a specific semantic capacity of the nondominant hemisphere but rather stress the fragility of the lexical-semantic organization at the cortical level.This work was assisted by a grant from C.N.R. (Consiglio Nazionale delle Ricerche).     

Auditory word comprehension impairment in acute stroke: relative contribution of phonemic versus semantic factors

Auditory word comprehension was assessed in a series of 289 acute left hemisphere stroke patients. Participants decided whether an auditorily presented word matched a picture. On different trials, words were presented with a matching picture, a semantic foil, or a phonemic foil. Participants had significantly more trouble with semantic foils across all levels of impairment.     

Speech dominance and handedness in the normal human

Spectral analysis was used to measure the coherence or similarity of form between occipital and temporal evoked potentials. In both right- and left-handers, coherence was greater in the left hemisphere for click stimuli and in the right hemisphere for flash stimuli. Similar asymmetries occurred in left but not right speech dominant patients whose speech lateralization has been determined by the intracarotid amytal test. Right-handers and males, however, showed significantly larger amplitudes of auditory responses in the right hemisphere. Left-handers and females reversed this pattern. It was concluded that within a basically left speech dominant organization, males and right-handers would emphasize the verbal, temporal structure of auditory information and the nonverbal, spatial structure of visual information. Females and left-handers would tend to reverse this emphasis.     

Self-monitoring behavior in a case of severe auditory agnosia with aphasia

This case report describes an unusual combination of speech and language deficits secondary to bilateral infarctions in a 62-year-old woman. The patient was administered an extensive series of speech, language, and audiologic tests and was found to exhibit a fluent aphasia in which reading and writing were extremely well preserved in comparison to auditory comprehension and oral expression, and a severe auditory agnosia. In spite of her auditory processing deficits, the patient exhibited unexpected self-monitoring ability and the capacity to form acoustic images on visual tasks. The manner in which she corrected and attempted to correct her phonemic errors, while ignoring semantic errors, suggests that different mechanisms may underlie the monitoring of these errors.     

Selective loss of complex-pitch or speech discrimination after unilateral lesion

Twenty-eight right-handed patients who suffered a single cerebrovascular accident in the distribution of either the left or right middle cerebral artery were tested on their ability to discriminate complex-pitch and speech stimuli presented dichotically. Whereas the left hemisphere lesion group was impaired in dichotic speech but not in dichotic complex-pitch discrimination, the right hemisphere lesion group was impaired in dichotic complex pitch but not in dichotic speech discrimination. Complex-pitch phenomena may provide a useful model for the study of auditory function in the nondominant hemisphere.     

Cerebral organization of oral and signed language responses: case study evidence from amytal and cortical stimulation studies

A normally hearing left-handed patient familiar with American Sign Language (ASL) was assessed under sodium amytal conditions and with left cortical stimulation in both oral speech and signed English. Lateralization was mixed but complementary in each language mode: the right hemisphere perfusion severely disrupted motoric aspects of both types of language expression, the left hemisphere perfusion specifically disrupted features of grammatical and semantic usage in each mode of expression. Both semantic and syntactic aspects of oral and signed responses were altered during left posterior temporal-parietal stimulation. Findings are discussed in terms of the neurological organization of ASL and linguistic organization in cases of early left hemisphere damage.     

Speech comprehension after unilateral injection of sodium amytal

A unilateral cerebral dominance model predicts that speech comprehension will be disrupted after injection of sodium amytal into one hemisphere but not after the other. This model was supported when an auditory receptive task involving relatively nonredundant stimuli similar to that contained in the Token Test (E. DeRenzi & L. Vignolo, 1962, Brain, 85, 665–687) was administered to 17 epileptic patients undergoing bilateral amytal injections.     

Language acquisition following hemidecortication: Linguistic superiority of the left over the right hemisphere

The language development of three 9- and 10-year-old children possessing only a right or a left hemisphere was studied. Surgical removal of one brain half antedated the beginning of speech, so each child has acquired speech and language with only one hemisphere. Different configurations of language skill have developed in the two isolated hemispheres: phonemic and semantic abilities are similarly developed but syntactic competence has been asymmetrically acquired. In relation to the left, the right brain half is deficient in understanding auditory language, especially when meaning is conveyed by syntactic diversity; detecting and correcting errors of surface syntactic structure; repeating stylistically permuted sentences; producing tag questions which match the grammatical features of a heard statement; determining sentence implication; integrating semantic and syntactic information to replace missing pronouns; and performing judgments of word interrelationships in sentences. Language development in an isolated right hemisphere, even under seizure-free conditions, results in incomplete language acquisition.     

左右半球在语篇理解中的协同作用

通过2例一侧颞叶损伤患者研究了一侧颞叶损伤及两侧半球的协同作用对语篇理解的影响,并探讨了发生此种影响的可能机制。结果表明一侧颞叶的损伤将导致患者语篇水平的理解障碍及语言推理能力的下降;提示语篇理解需双侧半球的协同作用,而推理能力下降可能是引发语篇理解障碍的原因之一。     

Lesion localization in acquired deficits of emotional expression and comprehension

This study investigated the relationship between intrahemispheric location of lesion and disturbances of emotional expression and comprehension. Twenty-eight right hemisphere strokes, 18 left hemisphere strokes, and 20 controls were examined on a standardized test of the expression, repetition, and comprehension of emotional prosody as well as the visual recognition of emotional situations and faces. The patients were classified into aprosodic syndromes according to the test scores. The lesions were independently traced, and overlapped for each aprosodic syndrome. The results, for lesions in either hemisphere, indicated involvement of the basal ganglia most frequently in aprosodic syndromes followed by anterior temporal lobe and insula lesions. Basal ganglia damage was also seen most frequently in patients with impaired comprehension of emotional facial expressions and situations. The anterior temporal lobe was also frequently involved in patients with such deficits. The basal ganglia emerged as a structure of particular importance in the mediation of emotional expression and comprehension.     

Persisting apraxia in two left-handed, aphasic patients with right-hemisphere lesions

Apraxia usually follows a left hemisphere lesion in right-handers with left hemisphere speech representation. Apraxia following a right hemisphere lesion in left-handers is rare, however, and not well documented in the literature. Two left-handed patients are described in whom apraxia and aphasia followed a right hemisphere lesion. Both the apraxic and the aphasic deficits improved but were still demonstrable 6 weeks following the infarct. The data are consistent with those for right-handers with left hemisphere lesions in suggesting some overlap of anatomical structures for the control of speech and praxis.     

Do temporal processes underlie left hemisphere dominance in speech perception?

It is not unusual to find it stated as a fact that the left hemisphere is specialized for the processing of rapid, or temporal aspects of sound, and that the dominance of the left hemisphere in the perception of speech can be a consequence of this specialization. In this review we explore the history of this claim and assess the weight of this assumption. We will demonstrate that instead of a supposed sensitivity of the left temporal lobe for the acoustic properties of speech, it is the right temporal lobe which shows a marked preference for certain properties of sounds, for example longer durations, or variations in pitch. We finish by outlining some alternative factors that contribute to the left lateralization of speech perception.     

Fluent versus nonfluent primary progressive aphasia: a comparison of clinical and functional neuroimaging features

To better characterize fluent and nonfluent variants of primary progressive aphasia (PPA). Although investigators have recognized both fluent and nonfluent patients with PPA, the clinical and neuroimaging features of these variants have not been fully defined. We present clinical and neuropsychological data on 47 PPA patients comparing the fluent (n=21) and nonfluent (n=26) subjects. We further compared language features with PET/SPECT data available on 39 of these patients. Compared to the nonfluent PPA patients, those with fluent PPA had greater impairment of confrontational naming and loss of single word comprehension. They also exhibited semantic paraphasic errors and loss of single word comprehension. Patients with nonfluent PPA were more likely to be female, were more often dysarthric, and exhibited phonological speech errors in the absence of semantic errors. No significant differences were seen with regard to left hemisphere abnormalities, suggesting that both variants result from mechanisms that overlap frontal, temporal, and parietal regions. Of the language measures, only semantic paraphasias were strongly localized, in this case to the left temporal lobe. Fluent and nonfluent forms of PPA are clinically distinguishable by letter fluency, single word comprehension, object naming, and types of paraphasic errors. Nevertheless, there is a large amount of overlap between dysfunctional anatomic regions associated with these syndromes.     

Role of the left hemisphere in sign language comprehension

We investigated the relative role of the left versus right hemisphere in the comprehension of American Sign Language (ASL). Nineteen lifelong signers with unilateral brain lesions [11 left hemisphere damaged (LHD) and 8 right hemisphere damaged (RHD)] performed three tasks, an isolated single-sign comprehension task, a sentence-level comprehension task involving simple one-step commands, and a sentence-level comprehension task involving more complex multiclause/multistep commands. Eighteen of the participants were deaf, one RHD subject was hearing and bilingual (ASL and English). Performance was examined in relation to two factors: whether the lesion was in the right or left hemisphere and whether the temporal lobe was involved. The LHD group performed significantly worse than the RHD group on all three tasks, confirming left hemisphere dominance for sign language comprehension. The group with left temporal lobe involvement was significantly impaired on all tasks, whereas each of the other three groups performed at better than 95% correct on the single sign and simple sentence comprehension tasks, with performance falling off only on the complex sentence comprehension items. A comparison with previously published data suggests that the degree of difficulty exhibited by the deaf RHD group on the complex sentences is comparable to that observed in hearing RHD subjects. Based on these findings we hypothesize (i) that deaf and hearing individuals have a similar degree of lateralization of language comprehension processes and (ii) that language comprehension depends primarily on the integrity of the left temporal lobe.     

An analysis of speech perception in word deafness

A patient with a rather pure word deafness showed extreme suppression of right ear signals under dichotic conditions, suggesting that speech signals were being processed in the right hemisphere. Systematic errors in the identification and discrimination of natural and synthetic stop consonants further indicated that speech sounds were not being processed in the normal manner. Auditory comprehension improved considerably however, when the range of speech stimuli was limited by contextual constraints. Possible implications for the mechanism of word deafness are discussed.     

Semantic dementia and persisting Wernicke's aphasia: linguistic and anatomical profiles

Few studies have directly compared the clinical and anatomical characteristics of patients with progressive aphasia to those of patients with aphasia caused by stroke. In the current study we examined fluent forms of aphasia in these two groups, specifically semantic dementia (SD) and persisting Wernicke’s aphasia (WA) due to stroke. We compared 10 patients with SD to 10 age- and education-matched patients with WA in three language domains: language comprehension (single words and sentences), spontaneous speech and visual semantics. Neuroanatomical involvement was analyzed using disease-specific image analysis techniques: voxel-based morphometry (VBM) for patients with SD and overlays of lesion digitized lesion reconstructions in patients with WA. Patients with SD and WA were both impaired on tasks that involved visual semantics, but patients with SD were less impaired in spontaneous speech and sentence comprehension. The anatomical findings showed that different regions were most affected in the two disorders: the left anterior temporal lobe in SD and the left posterior middle temporal gyrus in chronic WA. This study highlights that the two syndromes classically associated with language comprehension deficits in aphasia due to stroke and neurodegenerative disease are clinically distinct, most likely due to distinct distributions of damage in the temporal lobe.     

Cross-modal matching and association under sodium amytal

Anatomical and theoretical considerations, as well as experimental findings, have yielded conflicting points of view regarding the abilities of the right hemisphere in man to accomplish cross-modal transfer of information. Auditory—visual cross-modal matching (CMM) and association (CMA) abilities of the left and right hemisphere (LH and RH) were tested, using the Wada intracarotid sodium amytal technique. It was found that the RH performed slightly better on these tasks than the LH. These findings contrast with results of other techniques which indicate that the RH cannot perform CMM and CMA.